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Ella Webb (25), a graduate student, is the index client. Since her discharge in September 2026 she has lived in the Webb household with her parents, Sarah Webb (née Lindqvist, 49), an architect, and Marcus Webb (51), a civil engineer, married in 1999; her fraternal twin, Noah Webb (25), a paramedic; and her brother Owen Webb (22), a university student.

Presenting problem: Ella's bipolar disorder began at age 24 with a first manic episode in October 2025, the month of her grandfather's death; a second episode led to an admission to a psychiatric hospital in August 2026. Sarah, who has had depression since 2001, now runs Ella's care. Marcus thinks Sarah smothers her, and the couple fight about her treatment. Noah is unaffected and frightened of becoming ill.

Date convergence: the twins were born in 2001, the year their grandfather, Lars Lindqvist (1952–2001), a music teacher, died by suicide. Lars had bipolar disorder from age 27; his first manic episode came months after a stillbirth in 1979, when he and his wife lost their son Daniel Lindqvist, who is rarely spoken of.

Recent changes: Lars married Judith Lindqvist (née Cohen, 72), a retired school secretary and practising Jew, in 1976; she was widowed in 2001. Their children are Sarah, Daniel and Nathan Lindqvist (44), a bike mechanic whose bipolar disorder also began at age 24, with alcohol misuse from 2003, in remission (sober since 2015). After a manic relapse and a hospitalisation in 2023, Nathan and his son, Leo Lindqvist (14), a 9th grader with anxiety since 2023, moved into Judith's home, a temporary stay that continues. Nathan married Rachel Stein (41), a pharmacy technician, in 2010; they divorced in 2016. Rachel has had opioid use disorder since 2014, and Leo has not lived with her since 2023.

Marcus was married first to Lisa Moreno (52), a dental office manager, from 1995 until their divorce in 1998. Their son, Jake Webb (29), an insurance broker, is Ella's half-brother and Sarah's stepson, and stays out of it.

Extended family: Lars's parents, Erik Lindqvist (1924–1990), a dairy farmer, and Ingrid Lindqvist (née Berg, 1927–2011), a church organist, were Swedish immigrants from Värmland, Sweden, who married in 1949. Erik died of a stroke, leaving Ingrid widowed in 1990; she died of heart failure. Erik had suspected bipolar disorder from the 1950s, never treated: months in bed, then spending sprees that nearly lost the farm. Ingrid kept his spells from the neighbours. Erik's first wife, Astrid Lindqvist (née Nyberg, 1922–1947), a farm worker born in Värmland, Sweden, married him in 1944 and died of tuberculosis in 1947, when their son was one, leaving Erik widowed. That son, Gustav Lindqvist (80), a retired carpenter born in Värmland, Sweden, emigrated with his father and stepmother; he was raised as Ingrid's, told about his mother only at 18, and has had depression since age 40. Lars's older sister, Annika Lindqvist (76), a retired librarian, is the family historian.

Judith's parents, Morris Cohen (1920–1998), a tailor born in Łódź, Poland, and Ruth Cohen (née Adler, 1924–2015), a seamstress born in Kraków, Poland, were Polish Jewish immigrants and practising Jews who married in 1950. Morris survived the camps and never spoke of the war; he died of lung cancer, leaving Ruth widowed in 1998. Ruth had PTSD from 1945 and died of pneumonia.

Patterns: bipolar disorder runs through Erik, Lars, Nathan and Ella. Erik and Lars were hostile. Annika was her brother's caretaker and drove him to hospital in 1979 and 1994. Ruth focused on Judith, her only child, with constant fear; Judith in turn organised her life around Nathan, and the two are close. Lars and Judith were close but hostile, and Sarah, her father's confidante, was close to him and hostile with her mother: a triangle. A generation on it repeats: Sarah is close to Ella, Marcus and Sarah are hostile, and Marcus is distant from Ella. Nathan and Rachel are hostile.

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Jamal Miller (13), an 8th grader with ADHD diagnosed in 2021, is the index client. Since 2023 he has lived in Loretta's kinship home, a temporary placement with his grandmother, Loretta Jackson (60), a certified nursing assistant with diabetes since 2015. With them live his sisters, Aaliyah Miller (16), an 11th grader with anxiety since 2024, and Zoe Miller (9), a 4th grader with asthma since 2019; Zoe's fraternal twin, Zion Miller (9), a 4th grader; and their half-sister, Nevaeh Delgado (2), a toddler, who has had neonatal abstinence syndrome from birth and was placed with Loretta straight from the hospital. Since 2024 Loretta has been the legal guardian of Jamal, Aaliyah, Zoe, Zion and Nevaeh.

Presenting problem: fights at school and a shoplifting charge in 2026. Loretta says Jamal is "just like his father". A date convergence: Jamal was charged at 13, the age his father was at his first arrest, in 1998.

Recent changes: the children's mother, Tasha Miller (née Jackson, 39), unemployed, has had polysubstance use since 2006 and is still using; she lost custody in 2023 after an arrest for possession and misses most visits. She married DeShawn Miller (41), a barber, in 2009, and they separated in 2020. DeShawn has been in state prison since 2022 for drug distribution, with earliest release in 2029. Since 2019 he has had an affair with Keisha Brown (36), a retail manager; their son, Darius Brown (6), a kindergartner, is half-brother to Tasha's children, and Keisha takes him to visit DeShawn in prison. Since 2023 Tasha has lived with her partner, Ray Delgado (43), a day laborer with drug misuse and Nevaeh's father.

Extended family: Loretta married Curtis Jackson (1963–2018), a forklift operator, in 1986. He had alcohol misuse from 1985, drank through his children's childhoods, beat Terrence and died of a heart attack in 2018, leaving her widowed. Tasha's brother, Terrence Jackson (36), a peer recovery coach, had polysubstance use from 2008 and has been in remission since 2021; he attends NA. He married Alicia Jackson (née Reed, 35), an elementary school teacher, in 2018, and in 2022 they adopted Elijah Jackson (11), a 5th grader, from foster care; the three make up the Jackson–Reed household. Loretta's parents are Willie Johnson (1941–1999), a sanitation worker who died of lung cancer, and Hattie Johnson (80), a retired domestic worker; they married in 1964, Hattie was widowed in 1999, and she takes the grandchildren to church every Sunday. DeShawn's parents, Darnell Miller (1961–2004), a bus mechanic, and Bernice Miller (63), a school custodian, married in 1984; Darnell died of a gunshot wound in 2004, when DeShawn was 19, leaving Bernice widowed. Bernice petitioned for custody in 2023 and takes the children to visit their father monthly.

Patterns: Aaliyah is Zoe's caretaker; she parented her while their mother was using. Loretta, Tasha and Jamal form a triangle: Loretta and Tasha are close but hostile, Loretta is focused negatively on Jamal, and Tasha is distant from him. Jamal is close to his father and speaks to him every Sunday. Tasha and Keisha are hostile. Curtis was physically abusive to Terrence, who cut Tasha off in 2024 to protect his sobriety. The two grandmothers, Bernice and Loretta, are hostile, and Hattie is close to Loretta.

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Ama Mensah (11), born 2015, is the index patient. She has had asthma since 3, with two hospital admissions for exacerbations, and takes a daily inhaled corticosteroid and montelukast; she has also had atopic eczema since 1. Her identical twin, Abena Mensah (11), also born 2015, has had no wheeze, eczema or allergy to date. The twins are close. Their brother, Yaw Mensah (14), born 2012, has had a peanut allergy since 1 and carries adrenaline auto-injectors; asthma has been suspected since 13 because of exercise-induced wheeze, and spirometry is booked.
Their father, Kofi Mensah (43), born 1983, an accountant, had asthma from 4 and outgrew it by 14, so it is in remission; he has had allergic rhinitis since 12, with hay fever every summer. Their mum, Emma Mensah (née Clarke, 42), born 1984, a physiotherapist, has had atopic eczema on her hands since 1, managed with emollients. Kofi and Emma married in 2010 and live with all three children.
Kofi's older sister, Efua Mensah (47), born 1979, is a pharmacist with asthma since 7 that persisted into adulthood, and allergic rhinitis with a grass-pollen allergy since 7. Their parents both emigrated from Ghana and married in 1976. Kwabena Mensah (1948–2019) was a lorry driver with a forty-year smoking history from 18; he developed COPD at 62 and died of an infective exacerbation of COPD. Akosua Mensah (74), born 1952, a retired midwife, has had adult-onset asthma since 34, controlled on a preventer inhaler.

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Erik Virtanen (47), born 1979, a software architect, is the index patient. He was diagnosed with colorectal cancer at 46 and is having adjuvant chemotherapy; his tumour showed loss of MLH1 and PMS2 without MLH1 promoter hypermethylation, and germline testing confirmed him as an MLH1 carrier in 2025. He was born in 1979, the year his grandfather Eino died of colorectal cancer. Erik married Mei Lin Chen (46), born 1980, an architect with no cancer history, in 2007. They live with their fraternal twins, Leo Virtanen and Mia Virtanen (16), both born 2010 and both school students, who are at 50% risk; MLH1 testing will be offered at 18 and colonoscopy from 25. Erik is close to his mother and distant from his father.
Erik's parents are Matti Virtanen (72), born 1954, a retired civil engineer, and Debra Collins (70), born 1956, a hospice nurse. They married in 1977 and divorced in 1988, and their relationship is still hostile. Debra had depression from 32, after the divorce; it is in remission. Matti had colorectal cancer at 41, treated by right hemicolectomy and now in remission, and urothelial cancer of the left ureter at 70, which is under treatment; he was confirmed as an MLH1 carrier in 2025. In 1990 Matti married Sandra Virtanen (née Barrett, 67), born 1959, a bookkeeper. Matti and Sandra are close and live together; Sandra and Debra are hostile to each other. Their daughter, Anna Virtanen (35), born 1991, a veterinary nurse, is Erik's half-sister and close to him. She tested positive as an MLH1 carrier in 2025, a colorectal adenoma was removed at her first colonoscopy at 34, and she has had anxiety since 34.
Sandra was first married to Gary Mills (70), born 1956, a scaffolder, from 1982 until their divorce in 1987. Gary has had alcohol use disorder since 20 and has been cut off from their son since 1987. That son, Jordan Mills (42), born 1984, a chef, is Anna's half-brother and Erik's stepbrother, and is not a blood relative of the Virtanens. Jordan has had alcohol use disorder since 19; he has been sober since 2019, so it is in remission, and he attends AA. Sandra watches him closely for relapse. Jordan has lived with Kayla Reed (38), born 1988, a care assistant, since 2014. Kayla has had depression since 28, the year their daughter Ava Mills (10) was born, in 2016. Ava, a school student, is awaiting an assessment for ADHD, suspected since 8. The three live together.
Matti's parents both emigrated from Finland in 1954. His father, Eino Virtanen (1926–1979), a carpenter, had colorectal cancer at 47 and died of metastatic colorectal cancer at 53. His mother, Aino Virtanen (née Laine, 1929–2017), a homemaker, married Eino in 1950 and was widowed in 1979. In 1984 she married Walter Brooks (1921–2009), a retired postal worker, and was widowed again when he died of a stroke at 88. Aino developed dementia at 81 and died of it in 2017; her daughter Liisa was her caretaker until then.
Matti's sister, Liisa Mäkelä (née Virtanen, 74), born 1952, a retired teacher, had endometrial cancer at 48, treated by hysterectomy and in remission, and was confirmed as an MLH1 carrier in 2025. She married Pekka Mäkelä (77), born 1949, a retired paper-mill technician with no cancer history, in 1975. Their son, Mikko Mäkelä (43), born 1983, a logistics manager, tested negative for the family MLH1 variant in 2025. Mikko lived with Chloe Martin (41), born 1985, a hairdresser, from 2014 until they separated in 2024, and the separation is hostile. Their son, Oskar Mäkelä (9), born 2017, a school student, is not at risk because his father tested negative. Since 2024 Mikko and Oskar have been living with Pekka and Liisa as a temporary arrangement.

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This is a multi-agency child-welfare case with four generations. The index child is Jada Mendes.

Jada Mendes and her fraternal twin brother, Jalen Mendes, were born in 2012 to Ashley Dawson (born 1991) and Luis Mendes (born 1988). Both twins are 8th grade students. Jada has suspected anxiety, first noticed in 2024, and has long been Jalen's caretaker; Jalen has ADHD, diagnosed in 2019. Luis, a line cook, is an immigrant from Recife, Brazil. He and Ashley lived together from 2011 until they separated in 2017, and their relationship is hostile.

Ashley is unemployed. She has drug misuse that began in 2016 and depression since 2019. From 2018 she lived with Tyler Briggs (born 1990), a roofer with suspected drug misuse; they separated in 2022. Ashley and Tyler had a miscarriage in 2019, and their daughter Lily Briggs was born in 2020, making Lily the twins' half-sister. Lily is a preschool pupil with a speech delay identified in 2023. Tyler is distant from Lily. Ashley is now in residential treatment at Riverside Recovery Center.

The children were removed in 2024. The twins were placed in a temporary kinship household with their maternal aunt, Brenda Kowalski (née Dawson, born 1986), a medical receptionist, and her husband, Mike Kowalski (born 1984), an HVAC technician; they married in 2010. Mike is focused negatively on Jalen and blames him for the strain on the household. Lily was placed in foster care in 2024 with Martin Pruitt (born 1974), a civil engineer, and Gail Pruitt (born 1976), a foster carer and former teacher, who married in 2001. Their son Caleb Pruitt (born 2006) is a college student, and their daughter Hope Pruitt (born 2014), a 6th grade student, joined the family by adoption in 2016. Lily is close to Gail.

Brenda and Ashley's parents are Ray Dawson (born 1958), a long-haul trucker with alcohol misuse that began in 1978 and is now in recovery, and Linda Fisher (née Walsh, born 1960), a school bus driver with diabetes since 2015. Ray and Linda married in 1984 and divorced in 1995, and they are still hostile. In 1998 Linda married Gary Fisher (born 1956), a retired electrician, who is Ashley's stepfather; Linda and Gary live together. Linda and Gary are close, Gary and Ashley are hostile, and Linda and Ashley are close-hostile, so Linda is caught in a triangle between her husband and her daughter. Linda gives Brenda monthly financial support towards the twins' costs.

Linda's parents were Frank Walsh (1932–1998), a steelworker who died of heart disease diagnosed in 1990, and Irene Walsh (née Byrne, 1935–2019), a homemaker with dementia from 2013. They married in 1954, and Irene was widowed in 1998. Irene and Linda were close.

The agencies and the court. Since 2025 Ashley has had supervised contact with Jada, with Jalen and with Lily every other Sunday at Riverside, supervised by agency staff. Since 2024 Luis has had court-ordered visitation with Jada and with Jalen on alternate weekends. Renee Adler (born 1982), the county child welfare case manager, has had case manager contact with Brenda every month since 2024. Marcus Bell (born 1979), the middle school counsellor, is a support for Jada and sees her every week.

Date convergence: Irene died in the spring of 2019, Ashley's miscarriage followed weeks later, and both Ashley's depression and Jalen's ADHD diagnosis date from that same year.

The team must decide whether Ashley's progress supports reunification with all three children, and whether Lily can be placed with her half-siblings.

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Moreau Fine Foods is a four-generation family company. Laurent Moreau, the chief executive, is the client, and his claim to the succession is being contested.

The founders were Henri Moreau (1922–2004) and Claire Moreau (née Dubois, 1926–2011), who married in 1948. Both were immigrants from Lyon, France. Henri had heart disease diagnosed in 1990 and died of it in 2004; he was focused negatively on his son Philippe all his life. Claire had cancer in 1996 that went into remission, and she was close to her daughter Juliette. Henri set up the Moreau Family Trust.

Philippe Moreau (born 1950) is the chairman. He married Margaret Moreau (née Ellis, born 1952), a former interior designer, in 1975. They separated in 2024, and their relationship is hostile. Since 1988 Philippe has had an affair with Elena Vasquez (born 1962), a restaurant owner, and he has paid her secret financial support every month since 1988. Their son, Daniel Vasquez (born 1990), is vice president of sales, and Elena and Daniel are close. In 2020 Philippe gave Daniel shares, so Daniel owns shares in the company, which Laurent disputes. Philippe had a stroke in 2024 and has suspected alcohol misuse. Since the stroke he has been staying, as a temporary arrangement, with Elena and Daniel.

Philippe and Margaret have two children. Laurent Moreau (born 1977) has been chief executive since 2019, and his anxiety dates from that year. Margaret and Laurent are fused, while Philippe and Laurent are close-hostile, so Laurent sits in a triangle with his parents. Laurent and his half-brother Daniel are hostile rivals for the succession. Laurent married Anika Moreau (née Rao, born 1979), a cardiologist, in 2003. Their identical twin sons, Theo Moreau and Lucas Moreau, were born in 2005, and the twins are close. Laurent employs Theo as a management trainee, a job he started in 2025, while Lucas is a university student. Their daughter Ava Moreau (born 2012) is a middle school student, and Laurent, Anika and Ava live together.

Sophie Moreau (born 1980), Laurent's sister, is a documentary producer. She had an eating disorder from 1995 that is now in remission. She has been cut off from Philippe since 2012 but is close to her half-brother Daniel. Juliette is the trustee of the Moreau Family Trust and pays Sophie her distributions, so the trustee line runs from Juliette to Sophie.

Juliette Grant (née Moreau, born 1953), Philippe's sister, is a retired lawyer who holds the other half of the company. She married Robert Grant (born 1951), a retired surgeon, in 1978. Their daughter Nicole Grant (born 1981) is chief financial officer. In 2018 Juliette transferred shares to Nicole, so Nicole owns shares too. Nicole has had depression since 2014. She married Mark Hollis (born 1979), a commercial pilot, in 2006, and they divorced in 2014; they are still hostile. Their daughter Chloe Hollis (born 2008) is a high school student. In 2017 Nicole married Ben Adeyemi (born 1980), a software architect, who is Chloe's stepfather. Their son Leo Adeyemi (born 2019), Chloe's half-brother, is a 1st grade student with ADHD diagnosed in 2025. Nicole, Ben, Chloe and Leo live together.

Outside the family, Grace Lin (born 1965), the chief operating officer and the first non-family executive, has been a mentor to Daniel since 2021 and is preparing him for the top job.

Date convergence: Henri died in 2004, the year Margaret first learned about Daniel at Henri's funeral; her depression dates from that same year.

The board wants a succession plan that Juliette and Nicole, who hold the deciding votes, can support before Philippe's health forces the question.